Page 39 Acute Pain Management
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Acute pain associated with neurological disorders
Treatment of acute pain associated with neurological disorders is based largely on
evidence from trials for the treatment of a variety of chronic neuropathic pain states.
Orofacial pain
Dental extraction
1. Paracetamol 1000 mg provides safe and effective analgesia with minimal adverse effects,
following dental extraction (N) (Level I [Cochrane Review]).
2. Non‐selective NSAIDs, coxibs, paracetamol, opioids or tramadol provide effective
analgesia after dental extraction (U) (Level I).
3. Non‐selective NSAIDs or coxibs provide better analgesia with fewer adverse effects, than
paracetamol, paracetamol/opioid, paracetamol/tramadol, tramadol or weaker opioids, SUMMARY
following dental extraction (U) (Level I).
4. Perioperative steroid administration reduces swelling (S) but not pain (R) (Level I) and
reduces postoperative nausea (U) (Level II), following third molar extraction.
5. The combination of paracetamol with a non‐selective NSAID provides analgesia that is
superior to each drug given alone following third molar extraction (N) (Level II).
Tonsillectomy
6. Aspirin and some NSAIDs increase the risk of perioperative bleeding after tonsillectomy
(U) except in children (N) (Level I [Cochrane Review]).
7. Peritonsillar infiltration or topical application of local anaesthetics produces a modest
reduction in acute post‐tonsillectomy pain (R) with topical application and infiltration
being equally effective (N) (Level I).
8. Intraoperative dexamethasone administration reduces acute pain (S) (Level I), nausea
and vomiting (U) (Level I) post‐tonsillectomy, although there may be an increased
bleeding risk (N) (Level II).
9. Peritonsillar infiltration with tramadol or ketamine may reduce post‐tonsillectomy pain
and analgesia requirements, but was no more effective than equivalent doses
administered parenterally (N) (Level II).
Mucositis
10. Opioids, via PCA or a continuous infusion, provide effective analgesia in mucositis,
however PCA is associated with reduced opioid requirements and pain duration (U)
(Level I [Cochrane Review]).
11. Topical treatments, including oral cooling or povidone‐iodine solution, provide effective
analgesia in mucositis (N) (Level I).
12. Oral laser light therapy reduces mucositis pain and progression (N) (Level II).
Pharyngitis
13. Steroids improve analgesia in sore throat, in particular in severe and exudative conditions
(N) (Level I).
14. Paracetamol, nsNSAIDs or coxibs and opioids, administered as monotherapy or in
combination, are effective analgesics in acute pharyngitis (N) (Level I).
Acute pain management: scientific evidence xxxix
